The Free T3/Free T4 Ratio Predicts Relapse After Antithyroid Drug Withdrawal in Pediatric Autoimmune Hyperthyroidism
Authors' conclusion
The FT3/FT4 ratio, measured both at diagnosis and before ATD withdrawal, is a significant predictor of relapse in AH.
Study context
- Population
- Pediatric patients with autoimmune hyperthyroidism (AH) diagnosed 2000–2021 attempting to discontinue antithyroid drug (ATD) therapy48 discontinued ATD
- Participants
- 80 patients
- Exposure
- Relapse vs no relapse after ATD withdrawal
- Relapsen = 24
- Outcome
- Prognostic value of the FT3/FT4 ratio in predicting relapse
Main finding
As reported in the abstract
FT3/FT4 ratio at diagnosis
Relapsed
0.46
median
No relapse
0.36
median
P .001
Observational data: associations, not effects.
Further findings
| Outcome | No relapse | OR | P value |
|---|---|---|---|
| FT3/FT4 ratio at ATD withdrawalRelapsed vs No relapse | median 0.33 | P < 0.001 | |
| Independent predictors of relapse (multivariate analysis) | 7.18 | P .012 |
- Free T3 (FT3)/free T4 (FT4) ratio at ATD withdrawal: Relapsed median 0.43
Relapse after ATD discontinuation · predominantly within 12 months
- Relapsed among 48 who discontinued ATD
- 24 (50%)
FT3/FT4 ratio ≥0.42 at diagnosis predicting relapse
- Sensitivity
- 83%
- Specificity
- 66%
Independent predictors of relapse (multivariate analysis)
- Orbitopathy was an independent predictor of relapse
Univariate predictors of relapse
- Longer time to FT3 normalization associated with relapse
- P .02
- Orbitopathy associated with relapse
- P .039
Original publication
The Free T3/Free T4 Ratio Predicts Relapse After Antithyroid Drug Withdrawal in Pediatric Autoimmune Hyperthyroidism. J Clin Endocrinol Metab. Published 31 March 2026. doi:10.
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